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Acute Rhinosinusitis
Nicholas A. Koontz, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Acute rhinosinusitis (ARS)
            • Definitions

              • Adult ARS: Sinonasal inflammation lasting < 4 weeks & demonstrating sudden onset of symptoms
                • Symptoms: Both nasal congestion/obstruction or nasal discharge and facial pain/pressure or reduced smell
              • Pediatric ARS: Sinonasal inflammation lasting < 12 weeks & demonstrating sudden onset of symptoms
                • Symptoms: 2 or more of nasal congestion/obstruction, discolored nasal discharge, or cough
              • ARS is clinical diagnosis, which does not require imaging or endoscopy to make initial diagnosis
                • Image to assess for complications, surgical planning, or unclear clinical diagnosis (uncommon)
              • Classified into viral rhinosinusitis (VRS) vs. acute bacterial rhinosinusitis (ABRS) based on clinical presentation

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. DeBoer DL et al: Acute sinusitis. In StatPearls. Treasure Island: StatPearls Publishing, 2020
                                            2. Frerichs N et al: Rhinosinusitis and the role of imaging. Cleve Clin J Med. 87(8):485-92, 2020
                                            3. Orlandi RR et al: International consensus statement on rhinology and allergy: rhinosinusitis. Int Forum Allergy Rhinol. 11(3):213-739, 2020
                                            4. Expert panel on neurologic imaging et al: ACR Appropriateness Criteria® sinonasal disease. J Am Coll Radiol. 14(11S):S550-9, 2017
                                            5. Bergmark RW et al: Socioeconomic determinants of overnight and weekend emergency department use for acute rhinosinusitis. Laryngoscope. 125(11):2441-6, 2015
                                            6. Costa ML et al: Medical therapy vs surgery for recurrent acute rhinosinusitis. Int Forum Allergy Rhinol. 5(8):667-73, 2015
                                            7. Dankbaar JW et al: Imaging findings of the orbital and intracranial complications of acute bacterial rhinosinusitis. Insights Imaging. 6(5):509-18, 2015
                                            8. El-Hennawi DM et al: Comparative study of the efficacy of topical steroid and antibiotic combination therapy versus oral antibiotic alone when treating acute rhinosinusitis. J Laryngol Otol. 129(5):462-7, 2015
                                            9. Joshi VM et al: Imaging in sinonasal inflammatory disease. Neuroimaging Clin N Am. 25(4):549-68, 2015
                                            10. Khalid AN et al: Association of vitamin D status and acute rhinosinusitis: results from the United States National Health and Nutrition Examination Survey 2001-2006. Medicine (Baltimore). 94(40):e1447, 2015
                                            11. King D et al: Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst Rev. 4:CD006821, 2015
                                            12. Lee JH et al: Underestimation of rhinogenic causes in patients presenting to the emergency department with acute headache. Acta Neurol Taiwan. 24(2):37-42, 2015
                                            13. Rosenfeld RM et al: Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 152(2 Suppl):S1-S39, 2015
                                            14. Cornelius RS et al: ACR appropriateness criteria sinonasal disease. J Am Coll Radiol. 10(4):241-6, 2013
                                            15. Esposito S et al: Diagnosis of acute rhinosinusitis. Pediatr Allergy Immunol. 23 Suppl 22:17-9, 2012
                                            16. Bayonne E et al: Intracranial complications of rhinosinusitis. A review, typical imaging data and algorithm of management. Rhinology. 47(1):59-65, 2009
                                            17. Madani G et al: Sinonasal inflammatory disease. Semin Ultrasound CT MR. 30(1):17-24, 2009
                                            18. Saarakkala S et al: Comprehensive optimization process of paranasal sinus radiography. Acta Radiol. 2009 Apr;50(3):327-33. Erratum in: Acta Radiol. 50(5):575, 2009
                                            19. Pearlman AN et al: Review of current guidelines related to the diagnosis and treatment of rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg. 16(3):226-30, 2008
                                            20. Rosenfeld RM et al: Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg. 137(3 Suppl):S1-31, 2007
                                            21. Triulzi F et al: Imaging techniques in the diagnosis and management of rhinosinusitis in children. Pediatr Allergy Immunol. 18 Suppl 18:46-9, 2007
                                            22. Le Annie V et al: Making the call: the diagnosis of acute community-acquired bacterial sinusitis. Am J Rhinol. 20(6):658-61, 2006
                                            23. Mafee MF et al: Imaging of rhinosinusitis and its complications: plain film, CT, and MRI. Clin Rev Allergy Immunol. 30(3):165-86, 2006
                                            24. Anand VK: Epidemiology and economic impact of rhinosinusitis. Ann Otol Rhinol Laryngol Suppl. 193:3-5, 2004
                                            25. Piccirillo JF: Clinical practice. Acute bacterial sinusitis. N Engl J Med. 351(9):902-10, 2004
                                            26. Vázquez E et al: Complicated acute pediatric bacterial sinusitis: Imaging updated approach. Curr Probl Diagn Radiol. 33(3):127-45, 2004
                                            27. Zinreich SJ: Imaging for staging of rhinosinusitis. Ann Otol Rhinol Laryngol Suppl. 193:19-23, 2004
                                            28. Aalokken TM et al: Conventional sinus radiography compared with CT in the diagnosis of acute sinusitis. Dentomaxillofac Radiol. 32(1):60-2, 2003
                                            29. Reider JM et al: Do imaging studies aid diagnosis of acute sinusitis? J Fam Pract. 52(7):565-7; discussion 567, 2003
                                            30. Kenny TJ et al: Prospective analysis of sinus symptoms and correlation with paranasal computed tomography scan. Otolaryngol Head Neck Surg. 125(1):40-3, 2001
                                            31. Varonen H et al: Comparison of ultrasound, radiography, and clinical examination in the diagnosis of acute maxillary sinusitis: a systematic review. J Clin Epidemiol. 53(9):940-8, 2000
                                            32. Larson TL: Sinonasal inflammatory disease: pathophysiology, imaging, and surgery. Semin Ultrasound CT MR. 20(6):379-90, 1999
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Acute rhinosinusitis (ARS)
                                                      • Definitions

                                                        • Adult ARS: Sinonasal inflammation lasting < 4 weeks & demonstrating sudden onset of symptoms
                                                          • Symptoms: Both nasal congestion/obstruction or nasal discharge and facial pain/pressure or reduced smell
                                                        • Pediatric ARS: Sinonasal inflammation lasting < 12 weeks & demonstrating sudden onset of symptoms
                                                          • Symptoms: 2 or more of nasal congestion/obstruction, discolored nasal discharge, or cough
                                                        • ARS is clinical diagnosis, which does not require imaging or endoscopy to make initial diagnosis
                                                          • Image to assess for complications, surgical planning, or unclear clinical diagnosis (uncommon)
                                                        • Classified into viral rhinosinusitis (VRS) vs. acute bacterial rhinosinusitis (ABRS) based on clinical presentation

                                                      IMAGING

                                                      • General Features

                                                        • Radiographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. DeBoer DL et al: Acute sinusitis. In StatPearls. Treasure Island: StatPearls Publishing, 2020
                                                                                      2. Frerichs N et al: Rhinosinusitis and the role of imaging. Cleve Clin J Med. 87(8):485-92, 2020
                                                                                      3. Orlandi RR et al: International consensus statement on rhinology and allergy: rhinosinusitis. Int Forum Allergy Rhinol. 11(3):213-739, 2020
                                                                                      4. Expert panel on neurologic imaging et al: ACR Appropriateness Criteria® sinonasal disease. J Am Coll Radiol. 14(11S):S550-9, 2017
                                                                                      5. Bergmark RW et al: Socioeconomic determinants of overnight and weekend emergency department use for acute rhinosinusitis. Laryngoscope. 125(11):2441-6, 2015
                                                                                      6. Costa ML et al: Medical therapy vs surgery for recurrent acute rhinosinusitis. Int Forum Allergy Rhinol. 5(8):667-73, 2015
                                                                                      7. Dankbaar JW et al: Imaging findings of the orbital and intracranial complications of acute bacterial rhinosinusitis. Insights Imaging. 6(5):509-18, 2015
                                                                                      8. El-Hennawi DM et al: Comparative study of the efficacy of topical steroid and antibiotic combination therapy versus oral antibiotic alone when treating acute rhinosinusitis. J Laryngol Otol. 129(5):462-7, 2015
                                                                                      9. Joshi VM et al: Imaging in sinonasal inflammatory disease. Neuroimaging Clin N Am. 25(4):549-68, 2015
                                                                                      10. Khalid AN et al: Association of vitamin D status and acute rhinosinusitis: results from the United States National Health and Nutrition Examination Survey 2001-2006. Medicine (Baltimore). 94(40):e1447, 2015
                                                                                      11. King D et al: Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst Rev. 4:CD006821, 2015
                                                                                      12. Lee JH et al: Underestimation of rhinogenic causes in patients presenting to the emergency department with acute headache. Acta Neurol Taiwan. 24(2):37-42, 2015
                                                                                      13. Rosenfeld RM et al: Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 152(2 Suppl):S1-S39, 2015
                                                                                      14. Cornelius RS et al: ACR appropriateness criteria sinonasal disease. J Am Coll Radiol. 10(4):241-6, 2013
                                                                                      15. Esposito S et al: Diagnosis of acute rhinosinusitis. Pediatr Allergy Immunol. 23 Suppl 22:17-9, 2012
                                                                                      16. Bayonne E et al: Intracranial complications of rhinosinusitis. A review, typical imaging data and algorithm of management. Rhinology. 47(1):59-65, 2009
                                                                                      17. Madani G et al: Sinonasal inflammatory disease. Semin Ultrasound CT MR. 30(1):17-24, 2009
                                                                                      18. Saarakkala S et al: Comprehensive optimization process of paranasal sinus radiography. Acta Radiol. 2009 Apr;50(3):327-33. Erratum in: Acta Radiol. 50(5):575, 2009
                                                                                      19. Pearlman AN et al: Review of current guidelines related to the diagnosis and treatment of rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg. 16(3):226-30, 2008
                                                                                      20. Rosenfeld RM et al: Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg. 137(3 Suppl):S1-31, 2007
                                                                                      21. Triulzi F et al: Imaging techniques in the diagnosis and management of rhinosinusitis in children. Pediatr Allergy Immunol. 18 Suppl 18:46-9, 2007
                                                                                      22. Le Annie V et al: Making the call: the diagnosis of acute community-acquired bacterial sinusitis. Am J Rhinol. 20(6):658-61, 2006
                                                                                      23. Mafee MF et al: Imaging of rhinosinusitis and its complications: plain film, CT, and MRI. Clin Rev Allergy Immunol. 30(3):165-86, 2006
                                                                                      24. Anand VK: Epidemiology and economic impact of rhinosinusitis. Ann Otol Rhinol Laryngol Suppl. 193:3-5, 2004
                                                                                      25. Piccirillo JF: Clinical practice. Acute bacterial sinusitis. N Engl J Med. 351(9):902-10, 2004
                                                                                      26. Vázquez E et al: Complicated acute pediatric bacterial sinusitis: Imaging updated approach. Curr Probl Diagn Radiol. 33(3):127-45, 2004
                                                                                      27. Zinreich SJ: Imaging for staging of rhinosinusitis. Ann Otol Rhinol Laryngol Suppl. 193:19-23, 2004
                                                                                      28. Aalokken TM et al: Conventional sinus radiography compared with CT in the diagnosis of acute sinusitis. Dentomaxillofac Radiol. 32(1):60-2, 2003
                                                                                      29. Reider JM et al: Do imaging studies aid diagnosis of acute sinusitis? J Fam Pract. 52(7):565-7; discussion 567, 2003
                                                                                      30. Kenny TJ et al: Prospective analysis of sinus symptoms and correlation with paranasal computed tomography scan. Otolaryngol Head Neck Surg. 125(1):40-3, 2001
                                                                                      31. Varonen H et al: Comparison of ultrasound, radiography, and clinical examination in the diagnosis of acute maxillary sinusitis: a systematic review. J Clin Epidemiol. 53(9):940-8, 2000
                                                                                      32. Larson TL: Sinonasal inflammatory disease: pathophysiology, imaging, and surgery. Semin Ultrasound CT MR. 20(6):379-90, 1999